NPIMap

Organization Active NPI

Otaigbe Southern Medical Care, PLLC

  • Family Medicine Physician
  • Hattiesburg, MS
National Provider Identifier
1033537469
Registry record updated Apr 2, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
OTAIGBE SOUTHERN MEDICAL CARE, PLLC
Practice address
6600 U S Highway 98
Suite B
Hattiesburg, MS 39402-8441
Phone
(601) 261-2727
Fax
(601) 261-9847
NPI assigned
Apr 2, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mechelle Duckworth
Title
Ceo
Phone
(601) 296-3150

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

6600 U S Highway 98
Suite B
Hattiesburg, MS 39402-8441

Mailing address

6600 U S Highway 98
Suite B
Hattiesburg, MS 39402-8441
Phone (601) 261-2727

Other names 1

  • Southern Medical Care, PLLC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140710001840 MS Part B Supplier - Clinic/Group Practice 2769607514 Receives reassigned benefits from 5 practitioners
Practice locations: Hattiesburg, MS

National Provider Directory

National Provider Directory

Locations

10 Medical Blvd
Hattiesburg, MS 39401
Phone (601) 264-0357

6600 U S Highway 98
Hattiesburg, MS 39402

6600 U S Highway 98
#B
Hattiesburg, MS 39402
Phone (601) 261-2727

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1396396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1396396800000",
    "number": "1033537469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 U S HIGHWAY 98",
            "address_2": "SUITE B",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394028441",
            "telephone_number": "601-261-2727",
            "fax_number": "601-261-9847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6600 U S HIGHWAY 98",
            "address_2": "SUITE B",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394028441",
            "telephone_number": "601-261-2727",
            "fax_number": "601-261-9847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OTAIGBE SOUTHERN MEDICAL CARE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-02",
        "last_updated": "2014-04-02",
        "status": "A",
        "authorized_official_last_name": "DUCKWORTH",
        "authorized_official_first_name": "MECHELLE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "601-296-3150"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Medical Care, PLLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hattiesburg, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.